FP2-03THE POSITIVE CUT – <strong>OF</strong>F INDURATIONSIZE FOR TUBERCULIN REACTIVITY INCHILDREN WITH TUBERCULOSISINFECTION <strong>AND</strong> DISEASELuis Jr Tavu CHAN 1 , Gloriosa Catura GALINDEZ 2 ,Fe del MUNDO 3Pediatrics, Dr. Fe del Mundo Medical Center, Philippine PediatricsSociety 1 , Pediatrics, De los Santos Medical Center 2 , Pediatrics, Dr. Fe delMundo Medical Center, Philippine Pediatrics Society 3 ( Philippine)FP2-04ANTIFUNAL SUSCEPTIBILITY <strong>OF</strong>BLOODSTREAM C<strong>AND</strong>IDA ISOLATES IN ANEONATAL INTENSIVE CARE UNIT WITHROUTINE FLUCONAZOLE PROPHYLAXISTzong-Shiann Ho 1 , Shih-Ming Wang 1 , Ching-Fen Shen 2 ,Chien-Yen Huang 2 , Yuh-Jyh Lin 2 , Chyi-Her Lin 2 andChing-Chuan Liu 2, 3Department of Emergency Medicine 1 , Pediatrics 2 and Center for InfectionControl 3 , National Cheng Kung University and Hospital, TaiwanOBJECTIVE: In response to the urgent need in resolvingthe controversy as to the most appropriate cut off size forpositive tuberculin reactivity, a prospective research studywas conducted in the Philippines involving 360subjects.Children 3 months to 10 years old were included todetermine the most appropriate definition of a positivecut-off induration size for the (Mantoux 5-T.U. PPD- S)tuberculin test reaction in children with TB infection anddisease based on the statistical validity, clinical andepidemiological considerations.METHODS: Children three months to ten years old werescreened for TB using the 4 criteria for TB diagnosis inchildren; history of exposure to an infectious TB source;clinical manifestations suggestive of TB, chest radiographicevidence suggestive of TB and tuberculin skin test (PPD-SMantoux test 5 – T.U.) using 10 mm as the positiveinduration size. Based on the American Thoracic Society’sdefinition of TB disease, and the 1997 Philippine NationalConsensus on Childhood Tuberculosis classification of TB,the 360 subjects were classified into 4 main groups; Group 1(Normal Subjects), Group 2 (Tuberculosis ExposedChildren), Group 3 (TB Infection) and Group-4 (TBDisease). The true positive, true negative, false positive andfalse negative cases in this study were defined with regardthe tuberculin skin test reaction of the subject populationunder study. The sensitivity, specificity, positive andnegative predictive values and accuracy rate for 5 mm. to12 mm. induration sizes were computed. The sensitivity andspecificity of the different cut-off points were plotted in thereceiver operator curve (ROC) to illustrate the value thatwould turn the corner of the curve.MAIN RESULTS: The 8-mm. induration size revealed asensitivity of 78.36%, specificity of 89.16%, positivepredictive value (PPV) of 96.95%, negative predictive valueNPV of 48.37% and accuracy rate of 80.36%. In thereceiver’s operating curve, the 8 mm. induration was thevalue that turned the corner of the curve depicting the bestpositive cut off size. This size proved to be the bestpositive value for the PPD Mantoux test, in agreement withthe latest Philippine National TB prevalence survey.CONCLUSION: Although majority of our clinicians usethe 10 mm size as the positive cut off size, this studyshowed the 8 – mm. induration as the best value thatcould discriminate a positive from a negative tuberculinreaction in children with TB infection and those with TBdisease.OBJECTIVE: Fluconazole prophylaxis invery-low-birth-weight (VLBW, ≦1500g) neonates in neonatalintensive care units (NICU) reduces the incidence of invasivecandidiasis. However, it raises concerns for the development ofacquired fungal resistance and changes in fungal ecology. Thisstudy is aimed to evaluate the antifungal susceptibility ofbloodstream Candida isolates in a NICU with routinefluconazole prophylaxis.METHOD: A retrospective, hospital-based study wasconducted in a level III NICU which began universal six-weekfluconazole prophylaxis for VLBW preterm neonates in May,2002. All Candida isolates from bloodstream infection in theunit from May, 1999 to May, 2007 were speciated. Antifungalsusceptibilities of these species to flucytosine, amphotericin B,fluconazole, itraconazole and voriconazole were determined byATB FUNGUS 3 kit (Biomérieux corp.)MAIN RESULTS: Totally 40 Candia clinical isolates ofbloodstream infection, 15 before routine fluconazoleprophylaxis, were analyzed. C. albicans (52.5%) was the mostfrequently isolated species, followed by C. parapsilosis (30%),C. tropicalis (10%), C. lusitaniae (5%) and C. glabrata (2.5%).Fifteen (37.5%) Candida isolates were from VLBW neonates,seven (four C. albicans, two C. parapsilosis and one C.glabrata) of them were from patients with fluconazoleprophylaxis. Comparing the 5-year (2002–2007) prophylaxisperiod with the 3-year (1999–2002) preprophylaxis period, theoverall rates of nonalbicans infections were increased (26.6%vs. 60%, p=0.01). Besides, the rates of nonalbicans infectionsin VLBW neonates were comparable (25% vs. 42.8%, p=0.65).All the clinical isolates were susceptible to amphotericin B.Fluconazole-resistant Candida isolates were not found exceptone (C. tropicalis, also resistant to other azoles) in prophylaxisperiod.CONCLUSION: Universal fluconazole prophylaxis does notincrease the rate of antifungal resistance but increases thepresence of nonalabicans subspecies in bloodstream candidaisolates in NICU. Further prospective studies are needed forevaluating the long-term effects.[Keywords]Fluconazole Prophylaxis, Very-Low-Birth-Weight, NeonatalIntensive Care Unit, Antifungal Resistance, Candida BloodstreamInfection67
FP2-05EPIDEMIOLOGICAL FEATURES <strong>OF</strong>HEPATITIS B VIRUS (HBV) INFECTION INCHILDREN <strong>OF</strong> A MOUNTAINOUSMULTI-ETHNIC COMMUNITY AT THENORTHERN BORDER AREA <strong>OF</strong> VIETNAMNguyen Van Bang, Le Thi Kim Dung, Nguyen Thi VanAnh, Luong Cong Sy, Vu Thi Tuong VanHanoi Medical University/Pediatric Department, Bachmai Hospital, VietnamBACKGROUND <strong>AND</strong> AIMS: Hepatitis B virus(HBV) infection occupies a great concern in publichealth in Vietnam. This study aimed at (1) assessingthe prevalence of HBV infectin in children of amulti-ethnic community at the northern border ofVietnam, and (2) investigating factors related to HBVinfection in chldren of the community.POPULATION <strong>AND</strong> METHODS: An exploratorycross-sectional study was carried out on a populationof 482 children among 1146 of all members of 312households in a mountainous multi-ethnic community.HBV infection was determined as HbsAg (+) (ELISAtechnique). Risk factors for HBV infection in childrenwere assessed using multivariate logistic analysis.RESULTS: The overall HbsAg (+) rate in the wholestudy populution was 11.0% (126/1146). It was 9.3%(45/482) in children up to 18 years old and 12.2% inadults (81/664) (p
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